ABSTRACT
Introduction: Obstetric needs are health problems that necessitate EmOC services or interventions. The sum of incidence of pathologies (obstetric emergencies and complications) is taken as an indicator of obstetric need. The assessment of UON has never been articulated in studies conducted on EmOC in Ethiopia. This study identifies gaps and deficits in MOI for AMI in comparison to the existing need.
Objective: To assess UON in Emergency Obstetric services in hospitals of Addis Ababa.
Methodology: A Cross-sectional study was conducted from July-September 2006 on 625 mothers who delivered with Absolute Maternal Indication (AMI), Major Obstetric Intervention (MOI) and non-AMI in 19 hospitals of Addis Ababa 6 Public and 13 Private. The data collectors were Midwives working in the Obstetric units of the hospitals. They were trained on pre-tested structured formats. Data quality was ensured through continuous supervision.
Results: A total of 666 MOI were conducted and Caesarean section took the largest share 531(80.5%). The C/S rate per 100 births was 5.3%. The number of women with AMI was 367 where majority had Obstructed Labour 145(39.5%) The number of MOI done without AMI was 354 where majority were done for previous C/S 143 (40.4%) and foetal distress 127(35.9%). The odds of C/S in Private hospital 1.77 (1.09, 2.90) and daytime admission 1.61 (1.01, 2.57) was significantly higher than in public hospitals and night time admissions.
The results of the new born showed that 538(92.4%) were born alive and discharged alive. Some of the mothers 39(5.4%) had complication after delivery mainly sepsis and haemorrhage with 4 resulted in maternal deaths which occurred in public hospitals. The average hospital stay in days was 3.9 and 7.1 for private and public respectively where the difference of means was statistically significant (p=0.000). Nearly 9 out of 100 births which needed major obstetric intervention in Addis Ababa during the period of data collection (July17-September 17, 2006) did not receive it. In other words the deficit of MOI/AMI per 100 births is 9.46%.
Conclusion: The UON in Addis Ababa was higher than urban figures of other countries that underwent the UON exercise. The rural situation is expected to be worse than the capital where better socioeconomic indicators and several health facilities exist. If purely preventive measures are out of favor, the move towards managing maternal health through a hospital network still seems in its infancy. Finally, this study should not remain one more theoretical study, but should pave a way for practical and effective decisions to be taken which will through advocacy and resource mobilization allow the country to move out of the poverty of the maternal health services.
Words used: Unmet Obstetric Needs, Major Obstetric Intervention (MOI), Absolute Maternal Indication (AMI), non Absolute Maternal Indication (non AMI), Caesarean Section (C/S), Emergency Obstetric services.

Description:

A THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES ADDIS ABABA UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH.